29 Nov 13 09 Mar 18

Neglected people

With decades of experience, MSF takes time to develop a thorough understanding of the people we treat and the places in which we operate. For neglected people who can’t reach medical facilities, we take healthcare to them.

The word emergency conjures images of large-scale disasters, such as earthquakes or war. But a large part of MSF’s work focuses on hidden emergencies that, while receiving little media coverage, can be just as serious.

In every situation, MSF strives to ensure that we target people who may be overlooked by the authorities or by other aid groups. These might include prostitutes, street children, prisoners, drug addicts or the mentally ill. In some places, entire populations are systematically neglected by the relevant authorities for ethnic or political reasons.

When people are ostracized from society or are forgotten by their governments, MSF can step in to help heal their mental and physical wounds and bear witness to their struggles.

With decades of experience, MSF takes time to develop a thorough understanding of the people we treat and the places in which we operate. For neglected people who can’t reach medical facilities, we take healthcare to them.



In some countries, incarcerated people have little or no access to healthcare and poor living conditions. Malnutrition, dehydration, and skin and respiratory infections are common. In countries where tuberculosis is prevalent, overcrowded cells can become breeding grounds for the disease.

Since 2010, MSF has been working in three prisons in the Cambodian capital of Phnom Penh, where a quarter of the country’s prisoners are held. Our teams provide care and treatment for HIV and TB, and have introduced measures to improve infection control, such as a quarantine area in one of the prisons. 

To prevent patients from developing drug resistance, our staff provides follow-up treatment once prisoners are transferred or released. We make sure they have access to the drugs they need, as well as to medical services.


Violence, drug abuse and sex workers

In Tegucigalpa, the capital of Honduras, the homicide rate is the highest in the world. This is attributed to drug trafficking, in which gangs extort businesses, terrorize local people, and engage in vicious turf wars. People are often too scared to seek healthcare.

Many migrants in Honduras make a living as commercial sex workers or drug dealers, and the lack of healthcare, combined with the rapidly growing commercial sex trade, has led to a huge increase in sexually transmitted infections.

“I was raped when I was 17 years old,” said one 25-year-old female MSF patient in Honduras. “I became pregnant, and my family rejected me. I ran away and ended up in Tegucigalpa, where I became a prostitute to earn a living for my son and myself.

“I was full of resentment against people, I felt disoriented, I couldn’t talk to anyone and I didn’t trust anyone any more. When Eva [an MSF worker] sent me to a psychologist, I was very anxious, as I had many problems. However, since then, I feel less anger — when the psychologist listens to me, I cry out of relief. I feel that there are people who will listen and help me.”

On the street, MSF doctors diagnose people and provide first aid. Psychologists listen and provide counselling. People with more serious or chronic health problems and addictions are referred to our healthcare facilities, where MSF doctors and psychologists provide additional medical care for physical, sexual and psychological violence and support patients throughout their treatment.



Some 450 million people worldwide suffer from mental health disorders, according to the World Health Organization (WHO), but many are unable to access care.

In many countries, there are taboos around certain medical conditions — especially mental and psychological disorders, making it even more difficult for people to get the treatment they need.

“While I was in Dadaab, I saw dozens of people with mental health problems who had been chained up or shut away by their families, who were at a complete loss as to how to handle them,” said psychiatrist Pablo Melgar Gomez, who worked with MSF in Dadaab refugee camp in Kenya, from 2009 to 2010. “If we hadn’t intervened, they would be completely without hope of receiving psychiatric care and would still be chained up today.”

Some medical conditions, such as obstetric fistulas, can lead to sufferers being excluded from society. Fistulas — a hole between the vagina and rectum through which urine and stool leak continuously — are almost always caused by obstructed labour. They occur mainly in remote areas in Africa, where there are few hospitals or trained midwives, and obstetric care is scarce.

In most cases, women with fistulas develop psychological problems. Because of the physical symptoms, they will often be excluded from their communities and abandoned by their husbands, who will take new, “healthy” wives. 

In 2009, MSF built a Women’s Village adjacent to the general hospital in Abéché, Chad, where fistula sufferers can go to recuperate and receive psychological support, helping them to reintegrate into their communities.